title: [Successful life saving from brachiocephalic vein injury using cardiopulmonary bypass during video-assited thoracoscopic resection for a mediastinal tumor--a case report].
abstract: A 67-year-old man was scheduled for video-assited thoracoscopic resection of a mediastinal tumor under epidural and general anesthesia. During removal of the tumor about an hour 30 minutes after the start of the operation, pulseless electrical activity developed due to uncontrollable massive hemorrhage caused by laceration of the left brachiocephalic vein. After intravenous administration of epinephrine and fluid resuscitation, compatible red cell transfusion with a different ABO group and intraoperative autotransfusion were started. Hemodynamics was unstable although bleeding was stanched. Therefore, cardiopulmonary bypass (CPB) was initiated about 2.5 hours after blanching had started. As a result, bleeding from the laceration was reduced, and the laceration was repaired. The patient recovered uneventfully and had no complications. CPB should be considered for cases of uncontrollable bleeding from a central vein and should be initiated as soon as possible.
authors.affiliation: Department of Anesthesiology, Nippon Telegraph and Telephone East Corporation Sapporo Hospital, Sapporo 060-0061.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Edanaga
authors.forename: Aki
authors.initials: A
authors.lastname: Mizuguchi
authors.forename: Sachi
authors.initials: S
authors.lastname: Kato
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Mimura
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D016121:Brachiocephalic Veins / Q000293:injuries*; D002315:Cardiopulmonary Bypass; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome